Another Obamacare myth exposed: The California doctor 'boycott'

You may have heard recently that seven out of 10 California doctors were "boycotting" the state's Affordable Care Act exchange, known as Covered California.

At least, you've heard it if you've been following right-wing news sources such as Fox News, which is alive to the irony that so many physicians in "deep-blue California are rebelling against the state's Obamacare health insurance exchange and won't participate."

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Like every other mention of this statistic, the Fox story hangs it on Dr. Richard Thorp, a rural internist who is president of the California Medical Assn.

In the news business, this yarn would be classified as "interesting, if true." But there are a few problems with it, starting with: It's not true.

The "boycott" claim originated with Richard Pollock, a reporter at the conservative Washington Examiner, whose piece doesn't appear to reflect how the California exchange actually works.

"That article was wrong," says Molly Weedn, spokeswoman for the CMA. "We have no idea how many doctors are participating. We don't collect that data."

In fact, Pollock's sourcing for the data in his original article, which appeared Dec. 6, is highly questionable, if not flat-out worthless. Pollock revised his story on Tuesday after he got called on it by the CMA. He now says there's no organized boycott. But he's still seems to have the story wrong.

Covered California says that the doctors participating in its exchange plans include 100% of Kaiser Permanente's 14,000 California doctors, 43,000 taking HealthNet patients and 35,000 in Blue Shield's network. (There's probably some overlap between the latter two networks.)

Although all Kaiser doctors will be available to all Kaiser enrollees, not all the doctors in other insurance networks will be available to all those insurers' enrollees; there are reports that some may see patients only in non-exchange plans.

The narrowing of physician networks has long been a fact of life in American healthcare and didn't originate with the Affordable Care Act. It's a cost-saving trend and in some respects it makes sense: Insurers make reimbursement deals with doctors, and physicians who don't want to accept the proffered deals won't see that company's customers.

Judging from his original article, Pollock seems to think that Covered California somehow imposed a standard reimbursement rate on all the state's doctors, or perhaps that insurers in the exchange pegged all reimbursements to the state's low Medicaid reimbursement rate. Neither is true. Insurers made their own deals with doctors, and it's unlikely that they were pegged to Medicaid (known in California as Medi-Cal). It's possible that some were pegged to Medicare, which pays more than Medicaid, but plainly there wasn't a one-size-fits-all reimbursement figure for all insurers and all plans.

As for Pollock's 70% nonparticipation figure, he says he arrived at it after talking to "a half-dozen" independent insurance brokers and agents across the state. He told me their estimates were consistent.

The problem is that insurance agents have no way of estimating physician participation across the state; they're typically small businesses that tend to operate locally; they can check for a client to see if a particular doctor or group is participating in a plan, but they don't have access to a statewide database. They can concoct an estimate from what they see, but they're dealing with a specialized clientele and their vision is more likely to be myopic than Lasik-clear.

The CMA says Pollock offered his estimate of 70% nonparticipation to Thorp, the CMA president, who responded that it "wouldn't surprise" him.

That was an error on Thorp's part; since his own organization doesn't have its own estimate, he should have kept his mouth shut. But it's the Washington Examiner that erected its big alarmist story on the basis of this tiny little foundation, and it's the anti-Obamacare right-wing noise machine that pumped it up to the volume of a shriek.

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As for the very idea of an organized "boycott," Pollock's latest article states that "California’s budding doctor rebellion against Obamacare appears to be genuinely spontaneous, lacking leadership from a single individual or organization."

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This is known as taking a quarter-step back when a full step is required. What he should say isn't that "California's budding doctor rebellion" is "spontaneous," but that it's spurious. It exists in the mind of the Washington Examiner and has spread, like an epidemic, to a bunch of other susceptible patients in the news world. It should never have started, and it's high time it was eradicated.